A Longitudinal Study on Delirium in Nursing Homes

Objective: To investigate the evolution of delirium of nursing home (NH) residents and their possible predictors. Design: Post-hoc analysis of a prospective cohort assessment. Setting: Ninety NHs in Switzerland. Participants: Included 14,771 NH residents. Measurements: The Resident Assessment Instrument Minimum Data Set and the Nursing Home Confusion Assessment Method were used to determine follow-up of subsyndromal or full delirium in NH residents using discrete Markov chain modeling to describe long-term trajectories and multiple logistic regression analyses to determine predictors of the trajectories. Results: We identified four major types of delirium time courses in NH. Increasing severity of cognitive impairment and of depressive symptoms at the initial assessment predicted the different delirium time courses. Conclusion: More pronounced cognitive impairment and depressive symptoms at the initial assessment are associated with different subsequent evolutions of delirium. The presence and evolution of delirium in the first year after NH admission predicted the subsequent course of delirium until death.